Provider Demographics
NPI:1588628473
Name:VAN WESTEN, COREY MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:MICHAEL
Last Name:VAN WESTEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15850 W BLUEMOUND RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-6022
Mailing Address - Country:US
Mailing Address - Phone:262-226-8349
Mailing Address - Fax:262-226-8352
Practice Address - Street 1:15850 W BLUEMOUND RD
Practice Address - Street 2:SUITE 306
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-6022
Practice Address - Country:US
Practice Address - Phone:262-226-8349
Practice Address - Fax:262-226-8352
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4410-12111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1275814345OtherGROUP NPI
WI15886284733OtherINDIVIDUAL NPI
WI100002627Medicaid
IA39576OtherBLUE CROSS BLUE SHIELD
IAI15789Medicare UPIN